 Good evening, everyone. My name is Stephanie Mehta. I'm the CEO of a company called Mansuedo Ventures. We publish fast company and ink magazines. And I'm delighted to moderate today's panel on preparing for the next pandemic. As you know, roughly one human pathogen emerges every year. And any one of those novel pathogens could have the potential to be the next pandemic. Today we're going to explore the question of how the public and private sectors can work together to protect lives and livelihoods. There's already some interesting examples of public-private partnership just happening today. Comic Relief US announced a $10 million pledge to the Global Fund, which is the first private organization to announce a commitment to the Global Fund's seventh replenishment. The World Economic Forum continues to support a number of global public-private partnerships including the Pathogen Surveillance Initiatives. And there are so many other conversations happening here at the World Economic Forum that point to the importance of public-private partnerships. And we're going to explore a little bit on the panel today. Before I introduce our esteemed panelists, just a little bit of housekeeping. We will have a little bit of time at the end for audience Q&A. So please use Slido, the Slido app, in order to submit your questions. And I'll see them here on my iPad. And if you are going to use social media, if you're going to tweet or mention this panel, please include the hashtag W-E-F-22. So with that, let me introduce our panelists. Helen E. Clark is Board Chair, Partnership for Maternal at Newborn and Child Health for the World Health Organization. And she's also the Co-Chair of the Independent Panel for Pandemic Preparedness and Responsiveness. We also have with us, we're very fortunate to have President Paul Kagame, President of Rwanda, followed by Bill Gates, Co-Chair of the Bill and Melinda Gates Foundation, as well as the author of a new book about preventing the next pandemic. We're followed by Francis Sousa, who is the President and Chief Executive Officer of Illumina, Inc. And finally, Peter Sands, who is the Executive Director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Thank you all for being here. Thank you. I want to start with Bill Gates. Your new book is titled, How to Prevent the Next Pandemic, but this panel is about preparing for the next pandemic. So is the next pandemic really preventable? Well, the ideal is that when you have outbreaks that you detect them early and you contain them before they go global, less than 2% of the deaths are in the first 100 days. And infectious disease is an exponential phenomena. And so if you let it run, then it's very difficult to rein it back in. The true exemplars, the variance between the death rates in countries with similar GDPs is quite dramatic. You have almost a factor of 50 between the good performers and the poor performers, where sadly the U.S. is in that poor performer category. And there's clear things that they did. If those were done early around the outbreak, then you could prevent it from spreading to lots and lots of countries. So that certainly should be the goal, is to not let it go global. And we'll explore some of those very specific things that countries and institutions can do to help prevent the next pandemic. President Kagami, let me ask you, what do you see as the top lessons that we've learned about preparing for the next pandemic from dealing with the COVID-19 pandemic? To begin with, we have talked as if there is going to be a pandemic soon or later anyway. So we get prepared for that either to prevent it or stop it spreading as Bir has just said. But what we have learned, for example, from the perspective of our continent, we have to deal with capacity issues to begin with. We have to have the capacity to test, to treat, to administer vaccines, and so on and so forth. That is number one. Number two, the lessons we learned also show us that we have to avoid to always be dependent on others for things that our lives depend on. So that's why we seek to build manufacturing capacities for vaccines, like it's beginning to happen in different parts of our continent. The third would be if you look at across the continent, we have to, again, work together, have to put our resources, in which case, continentally, we have the CDC, the African CDC, also have the African Medicines Agency, and we have to build in their capacity to help all the countries of our continent, 55 countries. The other, I should say, we need really to focus. There is a lot in science and research and technology that we should be able to tap into to deal with all these crises. So we should make investments either in individual countries or again, continentally, and that's what we have been doing and seeking to do. Helen, your independent panel released a report in May of this year, and the title was Transforming or Tinkering. Inaction lays the groundwork for another pandemic, which is very sobering and very blunt. Can you talk a little bit about what is preventing private players and governments from taking the steps that you laid out in your initial reports? So in the initial report, we observed that there'd been previously around 16 different reports, reviews and commissions on this subject, most of which had never been acted on at all, which is part of the reason why we keep issuing progress and update reports to remind people that there is a good set of recommendations out there. But I think there's always a danger in this area that it falls victim to that cycle of panic and neglect. So we've had panic, right? But the reality is that political resolve to fight COVID is waning. Popular support for measures is waning. People are over COVID. The problem is it's not done with us, but we're in danger of losing this moment for transformative change. And let's face it, people are still dying in significant numbers every day. People are still developing long COVID every day. Low-income countries are horribly, horribly under-vaccinated. We've got issues here and now. I think another reason is that the package of things that has to happen is trans-sector. And there hasn't yet been an effort to try and bring together a head of state and government level focus on the range of things that needs to be done. We said this needs a special session at the General Assembly. It needs a negotiated political declaration that brings the different threads together. We're talking not just the WHO and health ecosystem. We're talking the WTOs. We're talking the IFIs. We're talking the wide range of foundations, players in the space. And so a lot of people are doing bits and pieces, but it's not looking like a coordinated push to get transformational change. And again, I really do want to come back to this idea of how we get that coordinated push. But, Peter, I'd like to ask you a little bit about the news that was made today. You know, share a little bit about why it was so significant. The $10 million itself is not the big number, although the Gates Foundation did more than match that number. But I also want you to talk a little bit about why it's important to address diseases like malaria, TB, in the context of this conversation about preventing the next pandemic. Well, first of all, we're really thrilled that Comic Relief US has announced this $10 million donation pledge to the Global Fund's seventh replenishment. Comic Relief has been a longstanding partner of the Global Fund, so it's great to see them recommitting to the next phase of the Global Fund's work. And as you noted, the Bill and Melinda Gates Foundation has kind of double matched it, bringing it up to $30 million. So thank you, Bill, for that. And this is our first private sector pledge for this replenishment campaign. Now, $30 million is a great start. The target is $18 billion, so we have a little ways to go. But it is incredibly important to have significant private sector engagement in the way the Global Fund works, both from a financial perspective, because quite frankly, development assistance for health budgets aren't going to meet the total requirements of all the needs that we face right now. But also because the private sector brings a set of capabilities. We have partnerships with tech companies, with Coca-Cola and Last Mile Distribution, all sorts of different partnerships. So it's not just the money. We like the money. But it's what comes with the money in terms of private sector skills and expertise. You asked about the link between AIDS, TB, and malaria diseases like that and pandemic preparedness. I think the starting point is that, actually, people don't really like thinking about pandemics. I mean, most of us want to wish COVID-19 over. Nobody's told the virus that. But the general attitude is that it's over. And what we've seen in the past is the public and political interest in investing against pandemics wanes really, really quickly. So if we want to sustain it, we have to do it in a way that actually delivers for people. And we can do that by investing smartly. And the way we do that is by investing in lab networks, community health workers, supply chains, primary health care facilities that simultaneously help countries defeat diseases like HIV, TB, and malaria and make us safer against future pathogens. And that isn't that hard to do. I mean, actually, many countries' responses to COVID-19 were based upon the infrastructure and capacities that have been put in place for HIV, TB, and malaria. I think we just have to be a bit more intentional in investing in multi-pathogen capability, in surge capacity, so that we do achieve those two objectives at once. Frances, can you talk a little bit about the role of innovation in helping us prepare or prevent the next pandemic? Sure. You know, we've recently just crossed over 15 million deaths associated with the pandemic. And that extreme suffering of the pandemic has really challenged scientists and physicians and technologists to deliver innovation to combat the pandemic. And as we look back on this period, I think we will recognize just the amount of breakthrough innovation that has happened over the last couple of years on many fronts. On the sequencing front, for example, which is technology that companies like Illumina provide, which, you know, we provide machines, you put in blood or saliva or plant material, we'll tell you the DNA in it. What's happened is over the last few years, the price of sequencing has dropped from $150,000 a genome in 2007 to $600 a genome today. So over a 99% drop in the price, and we've publicly committed to taking it down another 80% the next few years. What that's enabled is us to deploy sequencing around the world. And we've started to see that payoff in a number of ways. Right at the beginning of the pandemic, we were in Wuhan. You know, the first notification to the WHO was on December 31st, 2019. 10 days later, the viral genome was published. We were working in Shanghai on that. And then, you know, Stefan and Salad Moderna talks about the fact that they took that data. So they never had the live virus on their site. They used the genomic data coming off those machines to launch their vaccine development program. And then since then, we've seen sequencing now deployed around the world. Over 190 countries now have sequenced sequencing data on the virus in their countries. That's allowed us to watch and track how the virus is mutating, how it's spreading. And that informs whether the tools we're using, like diagnostics or therapeutics or vaccines, are going to hold. And it also helps us make policy decisions around, well, should we do a travel ban because we haven't yet seen local spread or is it too late to do that? Now, there's still more work to do. And while we have the components to prevent, the technology components to prevent a future pandemic, we now have to do work on the policy. I'll give you an example. When South Africa and Botswana raised the alarm about a new variant that they'd noticed, the knee-jerk reaction from the United States and Europe was to immediately put a travel ban on them. So instead of rewarding them for identifying a new variant that, by the way, was already circulating in Europe, the reaction was to punish them. And so we need policies in place that say, look, if a country identifies a variant, we need to help them. We need to do a surge of vaccines or therapeutics or testing. We need to help them financially and make it safe for countries to report that they see a virus emerging. And then we also need to make this a global infrastructure. We now know that, ultimately, we're only as strong as the weakest among us. And so we need a global surveillance infrastructure. I guess the good news is, as we're deploying this infrastructure around the world, it provides infrastructure not just to fight future pandemics, not just to fight future pathogen outbreaks, but also to help countries deal with other diseases, like cancer, for example. They can leverage the sequencing infrastructure or cardiovascular disease or genetic diseases. And so as we lay this out to fight the pandemic, we can emerge from this stronger. And we should make a commitment. You started with this. We can't prevent future outbreaks. Well, we should commit to say, this could be the last pandemic we see. Right. Let me follow up with Bill Gates on something that was really important about what Frances said, which was that you were in Wuhan. You were able to identify using next-generation sequencing the risk. But that information was not disseminated as widely as it should have been. And there was this degree of inaction. And before we even get to the policy piece, which is very important, I'd like to ask Bill Gates, since you cover this in your book, how do we come up with a coordinated effort? What is the path to creating some sort of global response so that we can help the weakest link get stronger? Well, there certainly was time enough for some countries to respond and have very, very mild pandemics. Ground zero, wherever the emergence takes place, is always going to have the toughest job. Will they see an elevation in respiratory symptoms? Will they see an elevation in deaths? Will they run a diagnostic panel? They're not gonna be sequencing everything. But when things, when you get an elevation or you get your normal diagnostic panel showing something unusual, then you've got to start sequencing. And so there could be more delay in reaction if we have a country with low capacity and we don't have a global team. People always talk about, oh, let's help countries do better. Yeah, we should help countries do better. But a lot of the pandemic risks are in countries when the next several decades will not have that local capacity. So you have to have global capacity. If you're serious about pandemics, you have to have global capacity that can come in and do those things. So we see that a lot. But here, we're lucky if this had been 10 years ago, some of these vaccine technologies did not exist. If it comes 10 years from now, we should have far, far better diagnostic technology that is be able to scale up every country within a month to diagnose their entire population. We should have much better therapeutics, some of which will be pathogen independent. And then, as we do come up with vaccines, we want vaccines that are infection blocking and long duration, which today, the vaccines have saved millions of lives, but they don't have a bunch in the way of duration and they're not good at infection blocking. President Kagame, how should health organizations and leaders sort of measure the humanitarian impact of pandemics and how should that factor into preparedness? Well, first of all, government's responsibility being really working out these policy measures and bringing in, they have to create the trust with the citizens. So as I said earlier, building these capacities also enables us to have a clear picture of what needs to be done in the country and where we need to put the investments. And like in Rwanda and Senegal, South Africa, Ghana, we are beginning to work together and working with the partners from across the world. For example, the four I have mentioned are working now with BioNTech to use the mRNA technology to start actually building capacity on the ground to resolve the other problem I said of always depending from how generous the rest of the world is going to be to us before we get to the vaccines. So we have to work across the private sector, government and then the citizens themselves. Like when this pandemic struck from the beginning and later on, even when vaccines were discovered, we relied so much for a long time on what we learned, the land that science tells us to prevent by the social distancing and of course the testing, hygiene and all kinds of things. We relied so much on that and it worked because we were able to communicate with the population and to mobilize them to use what was known and what was available before the vaccines to make sure that the population remains secure. So it's working across the board. It is being organized, it is building these capacities even internally. Like the company just mentioned, you are going to work with, you are going to transfer knowledge to local engineers do what they need to do in these countries, South Africa, Senegal, Ghana, and others around the way. Helen, what does an ideal coordinated response look like based on the work that you did on the independent panel and the precedence that we've been talking about? If you could design the perfect coordinated response, what are the elements of it? Well, every orchestra needs a conductor and so our proposal was to have a global response to the global health threats council. Not a novel thought, by the way, President Kequate of Tanzania chaired a panel back in Bunky Moons time as Secretary-General which called for such a council emerging out of support from the General Assembly to oversee, if you like, readiness across the system and hold actors to account because there are many moving parts. As I said, what's going to happen with WTO and troops? What's going to happen with this fund or that? What's going to happen with new legal instruments and really to have some independent oversight of all of the institutions that are head of state and government level would be quite helpful in our opinion and we would still like to see at the General Assembly this year a high level event where the heads of state like President Kagame would come, the negotiators would have prepared a declaration sort of setting out the reform path across the sectors. We think that the General Assembly, as it tended at a very high level, has the capacity to do that. But if I could just comment also on the humanitarian aspects, you know, this pandemic has had very uneven effect. It's been very hard on the elderly. It's been very hard on those with health vulnerabilities. It's been very hard on those who haven't been able to access any vaccines at all. And sometimes when you see reporting on who is dying in the course of the pandemic, it's almost eerily dismissed as, oh, well, they were old or sick anyway. Hang on a minute. I have a dad who's 100. I don't want him dying of COVID. He's not ready to go. And I think, you know, we really have to come back to our human values here. We have a responsibility to protect our populations. We have these huge health inequity issues of the undernourished, the immunocompromised, all sorts of health inequalities and we have left a lot of people very, very exposed, by, you know, a range of suboptimal national responses and then the inequality of vaccine and therapeutic rollouts. Peter, in addition to funding partnerships, you've also struck some really interesting partnerships with corporations. For example, I think you've got to deal with Pfizer. When it's not a financial contribution, but a contribution in kind or a letter of intent, can you talk a little bit about how those kinds of public-private partnerships can work? Well, obviously, as a big procurer of diagnostics, therapeutics, oxygen, all sorts of medical tools, we have a range of supply partnerships with different manufacturers. The one you referenced on Friday, we announced a letter of intent with Pfizer around the new oral antiviral and we are working with partners through the ACT Accelerator to support countries in getting access to these oral antivirals, but equally as importantly, in putting in place the testing strategies and clinical pathways to be able to use them because these oral antivirals have to be used pretty early in the first few days of people getting COVID and so you've got to have the testing, you've got to have the ability to decide which people it's appropriate for and get them on to treatment quickly. So there's a partnership with the manufacturer but there's also a partnership with a whole bunch of other actors to make this happen and I do think it's important that we do this because well, we would all like to believe that COVID-19 is going to sort of quietly march off into the sunset. I don't think it is. We will see more variants. We don't know what those variants would be like but the advantage of having more tools at our disposal and when I say our at everybody's disposal is that we can save a lot more lives to pick up on the point that Helen made about the inequities. There's been a lot of focus on the inequities in provision of vaccines, of treatments and it's absolutely right that we should focus on those and we should try and ensure equitable access as quickly as possible in this kind of situation but there's also a bit of an inequity that perhaps is less mentioned which is who gets to decide what counts as a pandemic and when does it stop counting as a pandemic? So the last big pandemic to strike humanity was HIV AIDS. We don't tend to talk about it as a pandemic anymore. The second biggest killer among infectious diseases is tuberculosis. We don't tend to talk about it and the reason we don't, I'm afraid, is because they don't pose a threat to people living in rich countries and we need to be careful that we don't just put the special effort on those things that pose a threat to people in rich countries and also that we don't end up with a trail of kind of residual pandemics where they're no longer threatening the people in rich countries but they're still killing a bunch of people in the poorer parts of the world. We need to kind of finish the job. Speaking of finishing the job, several panelists have mentioned that we all wish COVID were no longer a topic and that we kind of wish that pandemics would just go away. Bill, you've just published an op-ed that reminds us that even as we are contending with a war in Ukraine, even as we are contending with the potential for a recession, even as we're contending with high inflation, countries still need to, and leaders in private sector, still need to make pandemic preparedness or prevention a top priority. How do we do that when there are other concerns that keep creeping into the conversation? Well, we're certainly at risk that global health issues may get deprioritized as there's so much else going on, whether it's the ongoing pandemic or as Peter says, however you characterize HIV, malaria and TB, where the equity issue there is super dramatic. And it's good in a way that when infectious diseases hit rich countries, it reminds people, wow, we're not the only one suffering from this. What about these great tools that we have access to? When the prevalence goes down in the rich countries, that awareness tends to diminish. Now, various bilateral programs like US PEPFAR and the Multilateral Global Fund have done a good job reducing a lot of that inequity. But it'll be an interesting test. There's a replenishment that comes up probably in the last quarter where Global Fund is going to go out and ask for an increase from $14 billion to $18 billion. And we'll see in the face of all these priorities that are, I agree, absolutely important priorities can global health maintain the visibility that it deserves. Lots of work to do on this pandemic, lots of work to do on those three diseases and lots of work to do on those health systems. That's the front line for all the things we're talking about. And those investments are very dramatic in terms of the payoffs you get in terms of the human capacity you get by getting rid of these disease burdens. Maybe I'll add one other dimension to this discussion because public health funding is going to be an important factor here in terms of combating the future pandemic. But one of the realizations I think that people have been coming to over the last couple of years is that combating pathogens is not just a public health priority. It's also a defense priority. I remember I had this conversation in the White House actually in March of 2020 when we were sitting around and there was a realization that we could have been under a bioterrorist attack and been under attack for weeks and many, many people were dying and we didn't know the source, we didn't know how to combat it. And so I think there's sort of an increasing awareness that combating a pathogen is increasingly a defense priority too, that the next attack, yeah, it may be the next coronavirus or the next antimicrobial resistance, but it could be a bioterrorist weapon. So what that brings into the equation is that we're not just necessarily looking for public health funding, which unfortunately goes through surges and then dies off, but we should be accessing defense budgets too and those unfortunately tend to be more perennial. But we've got to remember that, again, fighting pathogens is not just a public health priority, it's a global defense priority too, increasingly going forward. Frances, at the top of the conversation you talked about the massive scientific effort that went into creating the vaccines and I have a tendency to make everything a talent conversation, so I apologize in advance, but are you seeing in biotech and in gene sequencing a renewed interest from young people who would otherwise have pursued careers at a company like Microsoft, say, now turning their attention and energies to healthcare vaccines next generation sequencing? That's a great question because, you know, as we think back on what this pandemic meant, I think there's a chance we think about the fact that this pandemic launched us into the 21st century in the same way that it was actually World War I, I believe that launched us into the 20th century and set the defining issues of that century and I think as we could be entering not just the 21st century, but the era of biology and the era of the genome and I think that as we start to think about some of the biggest challenges that we face, whether it's food security or fighting pandemics or climate change, increasingly biology is going to play a bigger and bigger role and if the 19th century was the era of the atom and the industrial revolution and the 20th century was the era of the bit and the digital revolution, we'll increasingly start to think about the 21st century as being an era of the genome and the biological revolution. Now what that means is we need a lot of talent to come to biology and we need a lot of talent from different fields. You know with sequencing we're digitizing biology which means increasingly we need more people with deep software expertise, with deep AI and machine learning expertise and we'll need that in a scale that we haven't seen before and I'll give you an example, even in the US, most doctors today went to med school before the first human genome was sequenced and so if you go to a doctor even where there are precision therapies available for things like cancer, many oncologists at the top of their field still don't go to sequencing yet and so there's a need for education and sort of talent building across the entire spectrum from continuing education of doctors and specialists through medical school and I think that Stanford and Harvard only started teaching genomics a few years ago through colleges, through high schools and yes we are seeing people that were traditionally in tech that have worked for the last decade in tech coming to biology and inspired by the work that's happened over the pandemic saying look I want to be part of this of this in the future. But biology, that biology is the biology of longevity, cancer multi-million dollar stem cell therapies it's not the biology of helping developing countries the percentage of the R&D budgets that go towards the things that cause the most deaths is well under 2% so there's a little bit of a mismatch of what the excitement is you know n equals 1 type Yeah and we need to change that I mean absolutely the priority going forward has to be much more around the needs of the developing world we cannot have this biology be a tool for the wealthy and so we saw that in the pandemic and we saw how we all have a vested interest in fighting this together and it doesn't matter if we fight it in the rich countries because it'll just keep mutating and coming back to attack us also we're realizing that we need the diversity of genomes to really come up with the best therapeutics and so for example today the genomic data sets are woefully underrepresented in terms of African genomes and Asian genomes and we realize that's creating poorer therapeutics so there's I think a need to make sure as Bill said that the way we spend our R&D in the past is not the same as we spend it in the future we can't be creating these multi-hundred thousand dollar immunotherapies if I had cancer that'll never make it into the developing world well let me go back to you Bill you're an investor you're somebody who cares deeply about innovation how do we incent innovators to focus on biology for the underserved market well it's a you know markets work for lots of things but markets do not work to incent investment in malaria eradication or you know TB vaccination those are incredibly expensive things that the affected countries you know don't have the resources and there's no market for those things so the term investor if that means you're seeking profit no I'm not an investor if it means trying to improve you know the 300,000 kids who die of malaria then yes the metric is always going to be life saved and the greatest underinvestment is still in infectious disease as we make progress there we will want to move up and do non-infectious disease non-communicable disease NCDs is the term people use and some of those the therapies are getting cheap enough now that they really are suitable for going global and making them available for everyone but we still have a lot left to do on infectious disease and the generosity of rich world governments is very important for that for pandemics it's different they should fund those things even if they only care about their own lives you know a insurance policy that costs a few billion that fairly often will save you trillions of dollars is a very very good deal so we shouldn't take the budgets of the you know helping out developing countries and divert that for pandemic pandemic money should come from health spending or just however you think of protecting your citizens while we continue a high level of generosity for the unique conditions in developing countries Peter you look like you want to get in here your body language I I just wanted to agree with that point which was that better pandemic preparedness for the world as a whole is at the expense of the lives of the people in the poorest communities that's not a great outcome we need to achieve both we need to do both simultaneously but I also wanted to pick up on your reference to talent I think one thing we have not done well in the global health community is come up with the equivalent of what the climate community did with green jobs of making investment in the people who do things around climate adaptation mitigation into a positive we tend to think of investments in health systems as being an expense but actually the investment in talent in community health workers in lab technicians in supply and logistics people in doctors and nurses these are great jobs these are sustained skills jobs providing people with career path they're also disproportionately jobs for women particularly community health workers and so as a way of promoting as well as promoting better health it's a really powerful mechanism but we haven't kind of sold it that way I'm afraid too many finance ministers I think still think of more investment in the health system as being a sort of negative on the PNL of the country rather than being an investment in great jobs which are part of the future of the economy I think on the funding it most definitely should not be coming from development assistance budgets heaven knows they are under incredible stress now we're seeing a number of the the good traditional donors diverting money from their budgets for refugee resettlement from Ukraine in their own countries and so on so to as Peter says to further rob the development assistance budget to pay for global public goods like pandemic preparedness and response would be reprehensible and so I guess a number of us are looking at the way this financial intermediary fund that's sort of coming out of the G20 type process we're looking at it with a lot of interest because it looks again like another donor fund which will come out of assistance budgets our panel felt that you need a kind of global public investment model to cater for investment in global public goods because a weak link of the chain anywhere is a threat to the health security of all so that's a different kinds of formulas and not drawing from the funds that should be going to the world's poorest President Konami I wanted to ask you a bit of a broader question about leadership what kind what leadership skills did you draw on the most in addressing the current pandemic and are those the same leadership skills that world leaders nonprofit leaders business leaders are going to have to apply to pandemic preparedness before I answer that let me come to a point adding to what has just been said learning again from the experience we have had in Africa in my country because if you look at across Africa only on average 18% of the populations have been vaccinated now that's a small number and the reason is that we did not invest enough in public health systems because even when people received vaccines they are not able to administer them some of them actually would spoil it stores so that speaks to the fact that there are certain investments we have to make even national budgets we have to I know countries developing countries have many priorities and but health building investing in health in health systems must be one of those priorities so that I wanted to mention that so back to your point the leadership qualities I mean some of these things in our experience in my country we have been we have been hard pressed to find solutions for many problems that have come almost at the same time and in fact we have not been able sometimes to identify which is a priority and which one is not so everything is a priority and we have to think about this as well as looking at the resources available many times limited but the people that must be served must be part of that solution when you are thinking about the outcomes and where you want to go so the leadership that is therefore required is to understand the problem specifically but how do you even introduce that prioritization as to what needs to come to be in place first before you get to another even in such difficult situations and being driven by the outcomes you want but also being able to measure at every step what are you doing does it need to change at a certain point do you need to do things differently and therefore or continue the other one and do it better so it's a broad question but leadership has to be there it has to be confronting the problem without excuses so in some of us have learned this hard lesson from dealing with these difficult problems of our society and that is Rwanda but it is similar to many other parts of our continent there is no finger pointing there is no blame here you just take it as your own and bring together all the resources human, financial others and see what can do and the best thing is that now the world has all kinds of tools that are science that are people who are going to help and thanks for example the innovation of the world putting the global fund there are philanthropies who want to help who are driven by the outcomes that we want so it's an interplay of so many things you know there are a range of leadership styles shown during the pandemic and without doubt I think the best responses came and followed the evidence in the science and didn't engender distrust and cynicism about it among their publics secondly on the basis of that communicated clearly with their publics including being honest about what we didn't know because we didn't know much at all initially and thirdly had empathy you know this was about people's lives and they were going to do whatever they could and people being first also tended to get the best economic responses because if you have a society that is fearful that's not good for an economy either if you have a society where people are falling sick unnecessarily because you haven't put in place the most basic public health measures that's not good for the economy so you know there were good examples across male and female leaders of these kinds of attributes the woman overall did pretty well a lot of them ended well as well and some did very badly well I just you know to repeat what you just said Helen following the data admitting what you don't know and showing empathy just seemed like good leadership skills will stop we do have time for a few questions from Slido but before we go to that you know the word innovation has come up a number of times Bill you have a chapter in your book dedicated to innovation as to preventing the next pandemic what do you see as the scientific technological process innovations that need to happen as part of this broader conversation about pandemic preparedness well it's fantastic that in the area of diagnostics you know we should be able to use low cost approaches that still report the data back and ramp those up there are a new generation of diagnostic machines like Lumira that can be used during and you're out for things like HIV and TB that then you know actually it got into after mostly because we had a COVID test authorized on it and now we'll move to to use it for those other things so diagnostic and the structure backed up by sequencing capacity that's very very important then in the therapeutic realm you know how do we get antivirals without waiting two years how do we get antibodies that contract the variants very rapidly and don't require infusion can we have drugs that are pathogen independent and stimulate the innate immune system so you can block infection and those could be used early on and then finally the profile for the vaccines for the operation and infection blocking and breath being important there you know so that's probably tens of billions but beneficial to so many diseases you know mRNA has some great characteristics so if we can add these other features in that you know it's a good chance that will be the solution for HIV and malaria you know we can probably move faster to develop those vaccines so we can see any other technology so you know besides the global monitoring piece the next big piece is that R&D agenda and then the hardest piece which we've all been talking about is the quality of the health systems in the countries themselves there's a question from the audience about any comments on AI driven infectious disease surveillance systems anyone on the panel have a thought on digital intelligence for surveillance you can use AI for a number of different things you can use it to detect disease patterns that are out of the ordinary and get you a better radar screen on that we also see applications for AI in things like TB case finding where you're trying to use you're trying to improve the yield essentially because testing is expensive so that you find the cases more effectively so I think we will see a range of uses of AI from disease surveillance to improving the efficacy of diagnostic efforts let me add one example that's playing out right now which is you know ideally we'd get to a world where we're doing automatic monitoring of the environment so you're seeing examples of wastewater monitoring for example say we'll do daily sequencing of samples but you want to add other forms of signal intelligence say we can do sequencing of communities through wastewater or other examples but we're also going to look at Google searches we're going to look at the temperatures reported by network thermometers for example and so integrating all this signal intelligence and trying to identify well what actually is indicative of an outbreak that's stuff where you can use machine learning and AI to start to say what pattern you know starts to be most indicative of outbreak so that's one example that's playing out right now there's also a question on Slido about the use and implementation of a global vaccine passport now we're not talking about the past so much as the future but does anybody on the panel have a thought about whether or not vaccine passports are valuable in the context of pandemic preparedness and prevention I'm not sure about a passport but I think what would be useful would be to have global standards of certification going back to the earlier times of vaccination in 2021 I was hearing from a friend who had family in Sweden who needed a particular vaccine to get there particularly one to get to the US particular one was available somewhere else getting global standards established as to what qualifies as protection I think would be useful so there's probably work to be done in this space it would be more valuable if you had an infection blocking vaccine the idea of checking if people are vaccinated if you have breakthrough infections what's the point but the data system some countries did a very good job on being able to verify vaccinated status the US did not but there's some great examples even India did a fantastic job on that and for our last question I'd like to ask each of the panelists to make the optimistic case for preventing the next pandemic if you had to say why the next pandemic would be prevented what would be the case for optimism I'm going to start with you Helen we have to believe that it's possible to stop a localized outbreak becoming a global pandemic and that means better surveillance more transparency frankly by all member states they think something's happened it's got to be reported and the WHO needs the power to be on the site with whatever teams need to be deployed it needs to be able to publish the information it has rather than big countries for permission to do it it's got to be able to take a precautionary approach and running up a flag and it's got to be able to declare an emergency without being kneecapped by an emergency committee these are basic things that need to be dealt with in a review of the international health regulations otherwise we will lose weeks again next time something happens President Kagame what makes you optimistic that will prevent the next pandemic the fact that I think we have all learned one lesson or the other as to the current pandemic a sense of urgency has kicked in and we know now which strings to pull and put things together and work together we might work together better in the next pandemic than we have done we have already done well to an extent working together so I think lessons we have learned should be able to be driving us in the right direction be reasonably rational to let tens of millions die all the negative effects of the pandemic cannot invest something society does a great job on fire prevention we have professional firefighters and we practice here the thing that I emphasize is practice how do you quickly get diagnostic capacity up how do you come up with these policies and communicate them we are not ready there is a strong correlation between the countries that had some risk of SARS-CoV-1 as being the best performers you can directly map that to the quick action they took between the room for innovation the scale of the tragedy I think we will we are a little distracted right now but I think it is happening slowly that is why this panel is so important is because it needs more discussion about exactly what form it takes but I think this one is not super expensive compared to the benefit the reason I am optimistic for the first time in human history we have the technology components necessary to think about even we have mRNA platforms we have low cost diagnostics we have sequencing all at price points that make it possible to think about preventing a pandemic we have also learned not just the humanitarian cost of a pandemic but the economic cost of a pandemic we have actually seen that bill come due and I think that will make us more likely to invest and finally we have realized that we are all in this together that we have to help everyone else because otherwise it keeps coming back after us and the lessons make me optimistic Peter I am going to give you the last word hard to add I do think that there have been some seed changes somebody who before I came to the global fund was trying to persuade businesses and the IMF to take pandemic threat seriously and was singly unsuccessful Covid did a much better job of that than I ever did so I think the point about the economics look we have some fantastic science and the more we can attract some of the best brains around the world to invest in this kind of stuff and spend that time on it I think will better protection the practice point the sad truth is we have plenty of diseases to practice on muscles used are far more effective the muscles left idle and by turbocharging the fight against infectious diseases that are killing people now we can protect people far better from the infectious diseases that might kill all of us well I'm glad we were able to end on an optimistic note this has been a tremendous panel I want to thank everybody Helen President Kikame